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Tropical sprue

Tropical sprue


Tropical sprue is a condition that occurs in people who live in or visit tropical areas for extended periods of time. It impairs nutrients from being absorbed from the intestines.

Tropical sprue (TS) is a syndrome characterized by acute or chronic diarrhea, weight loss, and malabsorption of nutrients.

This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines.

Risk factors are:

  • Living in the tropics
  • Long periods of travel to tropical destinations



Symptoms include:

  • Abdominal cramps
  • Diarrhea, worse on a high-fat diet
  • Excess gas (flatus)
  • Fatigue
  • Fever
  • Leg swelling
  • Weight loss

Symptoms may not appear for up to 10 years after leaving the tropics.


Exams and Tests


There is no clear marker or test that clearly diagnoses this problem.

Certain tests help to confirm that poor absorption of nutrients is present:

  • D-xylose is a lab test to see how well the intestines absorb a simple sugar
  • Tests of the stool to see if fat is absorbed correctly
  • Blood tests to measure iron, folate, vitamin B12, or vitamin D
  • Complete blood count (CBC)

Tests that examine the small intestine may include:

  • Enteroscopy
  • Upper endoscopy
  • Biopsy of the small intestine
  • Upper GI series




Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or Bactrim is typically given for 3 to 6 months.

In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.


Outlook (Prognosis)


The outcome is good with treatment.


Possible Complications


Vitamin and mineral deficiencies are common.

In children, sprue leads to:

  • Delay in the maturing of bones (skeletal maturation)
  • Growth failure


When to Contact a Medical Professional


Contact your health care provider if:

  • Tropical sprue symptoms get worse or do not improve with treatment.
  • You develop new symptoms.
  • You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics.




Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.




Ramakrishna BS. Tropical diarrhea and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 108.

Semrad SE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 131.

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    Tests for Tropical sprue


    Review Date: 10/25/2021

    Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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